Your brain needs blood to function, so when blood flow becomes restricted, problems can arise. One condition known as vertebrobasilar insufficiency refers to reduced blood flow to the back of the brain. Blood travels to the back of the brain through two vertebral arteries, which are joined by the basilar artery.
Blockage of these arteries can occur over time as a result of atherosclerosis – build up of plaque. Plaque deposits can occur from cholesterol, calcium, or other cellular components. Arteries not only become hard, but they become thicker and narrow, which restricts blood flow.
The vertebrobasilar arteries carry oxygen and glucose to the part of the brain responsible for consciousness, vision, coordination, balance, and other essential functions for daily life. When blood flow is restricted, it can have very serious consequences on brain cells. For example, a person with vertebrobasilar insufficiency has a higher risk of a mini-stroke, which results in temporary stoppage of brain function. If brain function is permanently lost, then a full-blown stroke occurs.
Prevalence of vertebrobasilar insufficiency
Roughly one in four strokes and mini-strokes occur as a result of vertebrobasilar insufficiency. It is most common among African Americans, affects men twice as much as women, and is most common among older adults over the age of 70.
What are the causes and risk factors of vertebrobasilar insufficiency?
The most common cause of vertebrobasilar insufficiency is atherosclerosis, which is caused by plaque build-up of cholesterol, calcium, or other cell components.
Risk factors for vertebrobasilar insufficiency include smoking, high blood pressure, diabetes, obesity, being over the age of 50, a family history of the disease, and having high blood lipid (fat) levels.
Types of vertebrobasilar insufficiency
There are different types of vertebrobasilar insufficiency that include structural, functional, and combined vertebrobasilar insufficiency. Structural vertebrobasilar insufficiency is when there are identifiable symptoms that occur as a result of an abnormality of the vertebral arteries or there are changes to the structure.
Functional vertebrobasilar insufficiency occurs when there are no structural abnormalities present, but patients complain of symptoms as a result of movements of the cervical spine.
Combined vertebrobasilar insufficiency results from a combination of structural and functional vertebrobasilar insufficiency.
What are the symptoms of vertebrobasilar insufficiency?
The condition causing vertebrobasilar insufficiency will determine the symptoms a person experiences. Symptoms may include loss of vision in one or both eyes, double vision, dizziness or vertigo, numbness or tingling in the hands or feet, nausea or vomiting, slurred speech, changes in mental state including confusion or loss of consciousness, sudden or severe weakness of the body, loss of balance or coordination, difficulty swallowing, and weakness in the body.
Symptoms may be temporary and come and go or they can be more persistent. If a person with vertebrobasilar insufficiency experience stroke-like symptoms, they should seek medical attention immediately. These symptoms include slurred speech, a droopy face, and arm weakness.
Diagnosing vertebrobasilar insufficiency
A physical examination is the first step your doctor will perform to diagnose vertebrobasilar insufficiency. The next step would be to complete laboratory procedures, imaging studies, and additional special tests.
Diagnostic methods include CT or MRI scans of the blood vessels at the back of the brain, magnetic resonance angiography (MRA), blood tests to evaluate clotting ability, echocardiograms, and angiograms. In rare cases, your doctor may request a spinal tap.
Treatment and prevention of vertebrobasilar insufficiency
There are several different approaches to treatment that your doctor can recommend. For starters, they can prescribe medications to control hypertension, lower blood cholesterol, and block platelet function.
Your doctor will also recommend lifestyle changes including quitting smoking, eating a healthy diet to reduce cholesterol levels, and regular exercise.
In some cases, your doctor can perform surgery as a means to restore blood flow to the brain through the arteries. Some procedures include bypassing the arteries by placing a new blood vessel on site. Another type of surgery sews two healthy vessels together. Lastly, the surgeon can remove the plaque affecting the arteries.
A newer technique is known as endovascular repair, where a catheter is placed in the artery through a small nick in the skin. A balloon is then placed within the artery and inflated. A metal stent is inserted to ensure the artery stays open to ensure that blood flow continues smoothly. After a short stay in the hospital, patients can resume their normal life.
Prevention tips for vertebrobasilar insufficiency include not smoking, controlling high blood pressure, cholesterol and glucose levels, eating a healthy diet high in fruits and vegetables and whole grains, and regular exercise.
Prognosis for a patient with vertebrobasilar insufficiency is positive as long as they adhere to treatment and live a healthy lifestyle.